History Of Surgery For Endometriosis Research Articles

Clinical and history features of patients with recurrent deep endometriosis: A retrospective study

Aim. To identify clinical and history features of patients with recurrent deep endometriosis (RDE). Materials and methods. A retrospective study of clinical and history data of 200 patients with DE undergoing surgical treatment at the Department of General Surgery of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology in 2020–2021. Group 1 included 80 patients with RDE, group 2 included 120 patients with newly diagnosed DE. All patients underwent surgical treatment followed by immunohistochemical examination and DE confirmation. Results. An association was found between the young age of the patient at the time of the first surgery and the type of endometriosis. It was found that women with a history of endometriosis surgery in early reproductive years (29.22±5.3 years) are at risk of recurrent endometriosis. Two or more surgeries were reported in 33.7% of RDE patients. In 90.2% of patients, endometriosis recurred with clinical manifestations; in 9.8%, it was asymptomatic and diagnosed on pelvic ultrasound. The group of RDE patients showed a longer period of infertility (5.432±3.53 years) than the group with newly diagnosed DE (2.953±1.29 years). It was found that the surgeries performed in RDE patients were longer, more complex, and associated with more blood loss. Intestinal resection, ureterolysis, adhesiolysis, and salpingectomy were significantly more common in the RDE group than in patients without a history of endometriosis surgery. Conclusion. In most cases, RDE is clinically manifested, rarely asymptomatic and diagnosed by visualization methods. Patients with a history of surgery at a younger age are at risk of RDE, and their surgical interventions are more complicated with more blood loss. Currently, surgical treatment of DE is the optimal method; however, it has serious disadvantages with severe and even life-threatening postoperative complications.

P-329 Oocyte donation outcomes in endometriosis patients with multiple IVF failures

Abstract Study question What are the reproductive outcomes and the prognostic factors of live birth rates in endometriosis patients referred to oocyte donation after multiple in vitro fertilization(IVF)-failures? Summary answer In this specific population, oocyte donation appears to be a viable option to optimize the reproductive outcomes, as the cumulative live birth rate reaches 63.2%. What is known already Assisted Reproductive Technology(ART) is currently recognized as one of the main therapeutic options to manage endometriosis-related infertility, often resulting in satisfactory outcome. A burning issue in this field remains how to deal with patients undergoing recurrent ART failures. As there appear to be two main factors contributing to the failures, i.e., a deleterious effect of endometriosis on embryo implantation and altered oocyte and embryo quality, two competing therapeutic strategies can be considered:(i) endometriosis surgery and (ii) oocyte donation. However, no data has been published to date in the specific population of endometriosis patients with previous IVF failures, undergoing oocyte donation. Study design, size, duration Observational cohort study including fifty-seven women with endometriosis-related infertility and multiple IVF failures (≥ 2 failed IVF cycles) referred to oocyte donation who consulted at our institution between January 2013 and June 2022. Participants/materials, setting, methods Endometriosis was diagnosed based on published imaging criteria using transvaginal sonography and magnetic resonance imaging and confirmed histologically in women who had a history of surgery for endometriosis. The main outcomes measured were the clinical pregnancy rate (CPR) and the cumulative live birth rate (CLBR). We compared the characteristics of women who had a live birth versus those who did not using univariate and multivariate analysis to identify determinant factors of fertility outcome. Main results and the role of chance Fifty-seven patients underwent 90 oocyte donation cycles, after 244 failed autologous IVF cycles. The mean age of the population was 36.8 ± 3.3 years, with a mean infertility duration of 3.6 ± 2.2 years, and a mean number of autologous IVF/ICSI cycles of 4.4 ± 2.3 cycles per patient. Three patients (5.3%) had superficial endometriosis, 2 patients (3.5%) had ovarian endometriomas, and 52 patients (91.2%) had deep infiltrating endometriosis, among which 30 patients (57.7%) had bowel lesions. Thirty patients (52.6%) had associated adenomyosis. Overall, the CPR and the CLBR per patient were 49/57 (85.9%) and 36/57 (63.2%), respectively. After multivariate analysis, only being nulligravida (p = 0.002) remained an independent negative predictive factor of the live birth rate. Limitations, reasons for caution In 35.1% of patients there was no surgical/histological proof of endometriosis. However, for all the study participants, endometriosis was diagnosed and staged using patient interviews, clinical examination, and imaging techniques to assess for endometriosis phenotypes, which is in line with the structured diagnostic process acknowledged as being appropriate for endometriosis. Wider implications of the findings In this specific population, poor embryo quality may be the main limiting factor of ART success rates, rather than impaired endometrial receptivity. These data are reason for clinicians not to systematically refer infertile endometriosis patients with recurrent IVF failures to surgery. Trial registration number not applicable

Oocyte donation outcomes in endometriosis patients with multiple IVF failures

What are the reproductive outcomes and the prognostic factors of live birth rates in patients with endometriosis referred to oocyte donation after multiple IVF failures? Observational cohort study including all women with endometriosis-related infertility and two or more failed IVF/intracytoplasmic sperm injection (ICSI) cycles referred to oocyte donation between January 2013 and June 2022. Endometriosis was diagnosed based on published imaging criteria, and was confirmed histologically in women who had a history of surgery for endometriosis. The main outcome measured was the cumulative live birth rate (CLBR). The characteristics of women who had a live birth were compared with those who did not using univariate and multivariate analysis to identify determinant factors of fertility outcome. Fifty-seven patients underwent 90 oocyte donation cycles after 244 failed autologous IVF cycles. The mean ± SD age of the population was 36.8 ± 3.3 years, with a mean duration of infertility of 3.6 ± 2.2 years, and a mean number of autologous IVF/ICSI cycles of 4.4 ± 2.3 cycles per patient. Three patients (5.3%) had superficial peritoneal endometriosis, two patients (3.5%) had ovarian endometriomas, and 52 patients (91.2%) had deep infiltrating endometriosis, among which 30 patients (57.7%) had bowel lesions. Thirty patients (52.6%) had associated adenomyosis. Overall, CLBR per patient was 36/57 (63.2%). After multivariate analysis, only being nulligravida (P=0.002) remained an independent negative predictive factor of the live birth rate. Previous surgery did not impact reproductive outcomes. This study suggests that oocyte donation appears to be a viable option to optimize the live birth rate in women with endometriosis-related infertility and recurrent IVF failures.

Risk Factors for Abscess Development in Patients with Endometrioma Who Present with an Acute Abdomen.

The objective of this study was to assess the potential risk factors for abscess development in patients with endometrioma who present with an acute abdomen. We retrospectively reviewed the records of 51 patients who underwent emergency surgery for acute abdomen involving an endometrioma at our hospital between April 2011 and August 2021. The patients were divided into an infected group (n = 22) and a control group (n = 29). We analyzed patient characteristics; imaging findings; clinical data, including bacterial cultures; and perioperative outcomes to assess for differences between groups. Patients in the infected group were significantly older than those in the control group (P = 0.03). They were more likely to have a history of endometriosis surgery (P = 0.04) and more likely to have undergone transvaginal manipulation within 3 months of presentation (P = 0.01). Body temperature on the day of admission was significantly higher in the infected group (P = 0.007), as were C-reactive protein levels on the day of admission and before surgery (P < 0.001; P = 0.018) and the white blood cell count on the day of admission (P = 0.016). Preoperative imaging showed significant thickening of the tumor wall (P < 0.001) and an enhanced contrast effect (P < 0.001) in the infected group. We identified several factors that suggest abscess in patients with an acute abdomen who have a complication of pathologically confirmed endometriosis. A recent vaginal procedure is a particular risk factor for abscess development in patients with endometriomas.

Opportunities and clinical significance of preoperative diagnosis of infiltrative endometriosis

Aim. To optimize preoperative diagnosis of infiltrative forms of genital endometriosis.&#x0D; Materials and methods. We analyzed the results of the preoperative examination and surgical treatment of 667 patients from 22 to 49 years old (31.4 [27.3; 34.2]) with external endometriosis presented with pelvic pain, dysmenorrhea, dyspareunia (n=580), and primary or secondary infertility (n=215). The duration of the disease ranged from 1 to 16 years. Seventy-eight (11.69%) patients had a history of surgery for external endometriosis. The serum concentration of the CA-125 tumor marker was measured by immunochemiluminescence assay. Colonoscopy was performed in 655 cases, and cystoscopy in 66 cases. In addition, pelvic ultrasound was performed for all patients. Pelvic magnetic resonance imaging (MRI) was performed with an intravenous bolus injection of a contrast agent.&#x0D; Results. Patients with endometrioid ovarian cysts (n=564) and "minor" forms of endometriosis (n=44) predominated. Endometrioid infiltrates occurred in 59 (8.84%) patients. In the group of patients with infiltrates, 18.64% had a history of surgery for endometriosis; 5.7% had a recurrence. Patients with retrocervical endometriosis and endometriosis of uterosacral ligaments predominated among females with infiltrative forms. No statistically significant differences in CA-125 concentration between patients with and without infiltrates were observed. The infiltrate was revealed, and its topography was described in 49 (83.05%) patients using ultrasound and 56 (94.81%) patients using MRI. All patients with dysuria had ultrasound, MRI, colonoscopy and cystoscopy.&#x0D; Conclusion. The combined use of pelvic ultrasound and MRI provides high accuracy in diagnosing infiltrative endometriosis.

Effect of the mode of delivery on the risk of endometriosis recurrence: a retrospective cohort study

To evaluate the risk of endometriosis recurrence according to the mode of delivery (cesarean section vs. vaginal birth) in patients who had become pregnant with a live birth after surgery for endometriosis. A retrospective cohort study. A Cox proportional-hazards regression was performed to evaluate the risk factors for endometriosis recurrence at 36 months of follow-up after the last pregnancy. Academic hospital. Patients who have had ≥1 pregnancy with a live birth following conservative surgery for ovarian endometriosis performed from January 2009 to December 2016 at our institution. Patients who underwent ≥1 cesarean section after surgery for endometriosis. The recurrence rate of endometriosis after live-birth pregnancies obtained after the first surgery for endometriosis. Patients with a history of ≥1 cesarean section after surgery for endometriosis have a higher risk of endometriosis recurrence than the patients who have had a vaginal birth, with an adjusted hazard ratio of 2.25 (95% confidence interval, 1.27-3.96). A cesarean section after surgery for endometriosis is associated with a twofold high risk of endometriosis recurrence with respect to vaginal birth. A different follow-up approach may be needed in those patients, and avoiding inappropriate indications for cesarean sections in pregnant patients with a history of surgery for endometriosis is necessary.

O-309 Surgery versus IVF/ICSI in infertile women with rectosigmoid endometriosis: the FERTILITY-RECTOSIGMOID study

Abstract Study question To compare the live birth rate in infertile patients with rectosigmoid endometriosis treated by surgery or IVF/ICSI. Summary answer In infertile women with rectosigmoid endometriosis, IVF/ICSI is associated with a higher live birth rate and a shorter time to conceive than first-line surgery. What is known already The choice between surgery and IVF/ICSI is based on several variables including concomitant infertility factors, presence of (sub)occlusive symptoms, preference of patients. Until now, there is no evidence to favor first-line IVF/ICSI or first-line surgery in women affected by rectosigmoid endometriosis wishing to conceive. Study design, size, duration This was a prospective patient’s preference study enrolling infertile women with rectosigmoid endometriosis who underwent first-line surgery or IVF/ICSI. Symptoms and fertility outcomes were compared between the two groups. Participants/materials, setting, methods Rectosigmoid endometriosis was diagnosed by transvaginal ultrasonography and magnetic resonance enema. All study patients underwent computed tomographic colonography (CTC) to assess the degree of stenosis of the intestinal lumen. Inclusion criteria were infertility; bilateral tubal patency; age &amp;lt; 40 years. Exclusion criteria were history of surgery for endometriosis; previous IVF/ICSI cycles; oocyte donation or vitrified oocyte procedures; poor ovarian reserve; estimated bowel stenosis &amp;gt; 70% at CTC; (sub)occlusive symptoms; oligospermia (sperm count &amp;lt; 15 million/mL). Main results and the role of chance Two hundred twenty-nine patients underwent IVF/ICSI. Patients underwent up to 4 IVF/ICSI cycles. Overall, 128 women had a live birth (55.9%; 95% C.I., 49.2%-62.4%). Two bowel sub occlusions occurred during IVF-ICSI. 198 patients underwent surgical treatment of rectosigmoid endometriosis. Nine patients have postoperative complications: four rectovaginal fistula, two anastomotic leakage, two pelvic abscess and one postoperative bleeding. At a median follow-up of 23 months after surgery (range, 12-56 months), 91 women had a live birth (44.9%; 95% C.I., 38.0%-56.1%). The live-birth rate was significantly higher in patients who underwent IVF/ICSI than in those who underwent surgery (p = 0.047). The time to conception that resulted in live birth was significantly shorter in patients who underwent IVF/ICSI (mean ± SD, 11.9 ± 7.6 months) than in those who underwent surgery (18.5 ± 8.1 months; p = 0.037). Six months after surgery or first IVF/ICSI cycle, there was a higher improvement of pain (p &amp;lt; 0.001) and intestinal symptoms (p &amp;lt; 0.001) in women surgically treated. No bowel endometriosis-related complication occurred during pregnancy. There was no difference in perinatal outcomes between the two groups. Limitations, reasons for caution The nonrandom allocation to treatments and the relatively small sample sized limits the strength of our results. Wider implications of the findings IVF/ICSI is associated with a higher live birth rate and a shorter time to conceive than surgery. The disadvantages of IVF/ICSI are potential endometriosis-related complications during the procedure and persistence of symptoms. Surgery improves symptoms but it has a higher risk of postoperative complications, which may negatively impact spontaneous conception. Trial registration number CE Liguria - ID 10766 - n. 394 (Approval: 10/2020)

Association of preoperative Enzian score with postoperative fertility in patients with deep pelvic endometriosis

IntroductionEndometriosis is a chronic inflammatory disease with a negative impact on fertility. The Enzian classification provides a precise description of deep pelvic endometriotic lesions, especially in the retroperitoneal area, from preoperative pelvic MRI scans. However, it is not known if it is correlated with postoperative fertility. Study objectiveTo determine if there is an association between the preoperative Enzian score and postoperative fertility after deep pelvic endometriosis surgery. DesignWe conducted a descriptive, retrospective study using information from the ENDOREN database. SettingThis was a retrospective study at the Department of Obstetrics and Gynecology at Rennes University Hospital (France) from January 2013 to May 2019 Patients and interventionsWe used information from the ENDOREN database that included all women who underwent surgery for deep endometriosis and wish to conceive. This surgery was intended in a view to achieve a complete removal of endometriosis. MeasurementsThe Enzian score was calculated from preoperative MRI scans, and total, spontaneous, and after In Vitro fertilization (IVF) live births and pregnancies outcomes were collected from the patients'computerized medical records. Univariate and multivariate analysis was performed. ResultsSixty-eight patients were included. The live-birth rate was 35% (24/68). According to the Enzian classification, 25 patients (35%) were classified in compartment A, 64 patients (94%) in compartment B, and 27 (40%) in compartment C. In multivariate analysis, positive predictor of live birth was single Enzian B score (OR=4.7[1.21; 18.81], p = 0.03), negative predictors were uterine adenomyosis and a history of endometriosis surgery. In multivariate analysis, positive predictor of spontaneous live birth was EFI score ≥7 (OR =22.434; CI [1.138; 442.190]). In multivariate analysis, positive predictor was Enzian A score (OR=15.9[2.2; 114.7], p = 0.006), and negative predictors was uterine adenomyosis and Enzian B score (OR=0.01[0; 0.495], p = 0.02) for live birth after IVF. ConclusionThe present retrospective study cannot strongly conclude about fertility and correlation with Enzian score because the groups are too small. However, it seems that when solely the compartment B is involved by endometriosis, complete full removal of endometriosis leads to better post-operative live births results. Other studies must be done to determine if Enzian classification based on preoperative pelvic MRI could be clinical value in the decision-making strategy for managing infertile patients with deep pelvic endometriosis.

Influence of laparoscopic surgery for endometriosis and its recurrence on perinatal outcomes.

PurposeIt is unknown whether surgery for endometriosis or recurrence of endometriosis affects obstetric outcomes.MethodsA total of 208 pregnant women with a history of endometriosis were analyzed. Patients who had endometriomas >3 cm and no history of laparoscopic surgery for endometriosis were defined as non‐surgery group (n = 60), while those who had a history of surgery for endometriosis (n = 148) were defined as surgery group. We investigated the obstetric outcomes in 208 patients according to with or without postoperative recurrence of endometriosis and the time from surgery to pregnancy.ResultsAmong 177 cases of on‐going pregnancy, in surgery group, there were lower prevalence of placenta previa compared with non‐surgery group (8.5% vs. 23.4%; p = 0.020). Subgroup analysis revealed a decreased prevalence of placenta previa in postoperative non‐recurrence group (6.0%: p = 0.007) compared with non‐surgery (23.4%) and postoperative recurrence group (28.6%). Placenta previa was more prevalent in the patients who got pregnant more than 2 years after surgery (20.0%) than the patients who got pregnant within 2 years (2.4%: p = 0.002). Multivariate analysis revealed that the surgery was associated with a reduction in placenta previa (OR: 0.32, 95% CI [0.11–0.90]; p = 0.032).ConclusionsPregnancy within two years after laparoscopic surgery for endometriosis may reduce placenta previa.

A History of Endometriosis Is Associated With Decreased Peripheral NK Cytotoxicity and Increased Infiltration of Uterine CD68+ Macrophages.

Women with endometriosis may have a defective immune system. However, evidence of the immune responses of endometriosis patients with a history of endometriosis surgery is lacking, and the association between the location of endometriosis lesions and immune responses is unclear. This retrospective study included 117 females with reproductive failure and a history of endometriosis and 200 females with reproductive failure but without endometriosis to analyze their endometrial and peripheral immune responses. The results show that endometriosis was associated with decreased peripheral natural killer (NK) cytotoxicity and increased uterine macrophages. Peripheral NK cytotoxicity at effector-to-target ratios of 25:1 and 50:1 was significantly reduced in women with a history of endometriosis from that of the control group (26.6% versus 33.3% and 36.1% versus 43.3%, respectively, both P < 0.001). Furthermore, after further division of patients into three subgroups according to the location of endometriosis lesions, we observed that NK cytotoxicity in the endometriosis subgroups, especially the mixed endometriosis group, was strongly decreased from that of the controls (P = 0.001). The endometrial CD68+ macrophage proportion in the mixed endometriosis subgroup was higher than that in the control group (2.8% versus 2.1%, P = 0.043). In addition, the baseline estradiol (E2) level was weakly correlated with the percentage of endometrial macrophages (r = 0.251, P = 0.009), indicating a potential association among the endocrine system, endometrial immune environment, and endometriosis. This study indicated that peripheral NK cytotoxicity and endometrial immune cell profiles could be useful for diagnosing and treating endometriosis and endometriosis-related reproductive diseases.

Endometriosis and spontaneous hemoperitoneum in pregnancy: evaluation of the magnitude of the risk in women becoming pregnant via in vitro fertilization

To estimate the frequency of spontaneous hemoperitoneum in pregnancy (SHiP) in women with endometriosis achieving pregnancy with invitro fertilization (IVF). Retrospective case series. Referral academic assisted reproductive technology (ART) center. Three hundred and forty-eight women with a history of surgery for endometriosis and women with ovarian endometriomas or deep endometriotic nodules detected at basal transvaginal ultrasound performed before IVF cycle. Information obtained from patients' charts on basal characteristics, IVF cycle, and pregnancy outcomes, and binomial distribution model created to determine the 95% confidence interval (CI) of the proportion of SHiP. Rate of SHiP. Overall, 362 pregnancies were included, among which 238 (66%) had a history of previous surgery for endometriosis and 231 (64%) had endometriosis detected at ultrasound (107 women, 30%, had both). Pregnancies were achieved after fresh and frozen cycles in 244 (67%) and 118 (33%) women, respectively. One case of SHiP was recorded, corresponding to a rate of 0.3%. In the general population of women with endometriosis undergoing IVF, SHiP is uncommon. Future studies should better identify the risk factors for SHiP to disentangle the subgroups of women at higher risk.

Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates

To evaluate the assisted reproductive technology (ART) cumulative live-birth rate (LBR) in a cohort of bowel endometriosis patients with no prior history of surgery for endometriosis. Prospective cohort study. University hospital. One hundred and one consecutive infertile bowel-endometriosis patients with no prior history of surgery for endometriosis in whom the diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging. First-line ART. Cumulative LBR, with statistical analysis via Kaplan Meier method with a "conservative" method, whereby it was assumed that no live births took place for patients who did not return. Between January 2016 and December 2018, 101 bowel endometriosis patients underwent 176 ART cycles. The mean number of deep-infiltrating endometriosis lesions per patient was 3 ± 0.9, with a mean number of bowel lesions of 1.3 ± 0.6. Seventy-three percent of the patients had associated endometriomas, and 88.1% had associated adenomyosis. Overall, the cumulative LBR after four ART cycles was 64.4%, using the conservative Kaplan-Meier method. The ART cumulative LBR was very satisfactory (64.4%) in bowel endometriosis patients with no prior history of surgery for endometriosis. In light of these data, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery because as first-line ART appears to offer satisfactory results.

Pregnancy outcomes in women with history of surgery for endometriosis

To assess the relationship between history of surgery for endometriosis and adverse obstetrical outcomes. Retrospective study using prospectively recorded data. Referral center. Total of 569 women with history of surgery for endometriosis, postoperative conception, and pregnancy evolution over 22 weeks of gestation. Surgery for endometriosis. Small for gestational age (SGA) status of the newborn, spontaneous preterm birth (PT, before 37 weeks' gestation), and placenta previa. Among 733 pregnancies included in the study, 566 deliveries were recorded (77.2%), of which 535 were singleton (72.9% of pregnancies) and 31 twins (4.2%). SGA was observed in 81 of 535 (15.1%) singleton pregnancies and in 9 of 31 (29%) twin pregnancies. PT occurred in 53 of 535 (9.9%) singleton pregnancies and in 19 of 31 (61.2%) twin pregnancies. The number of singleton and multiple pregnancies complicated by placenta previa were, respectively, 9 of 535 (1.7%) and 0 of 31. The independent factor found to relate to SGA was the absence of endometriomas; conception with the use of assisted reproductive technologies (ART) only tended toward statistical significance. Independent factors found to increase risk of PT were conception with the use of ART, body mass index >30 kg/m2, and surgery of deep endometriosis infiltrating the rectum and the bladder. Independent factors associated with placenta previa were conception with the use of ART and history of stage III or IV endometriosis. The risk of SGA and PT is increased in women with a history of surgery for endometriosis, and a high rate of conception with the use of ART may jeopardize outcomes.

Deep Infiltrating Endometriosis: a Previous History of Surgery for Endometriosis May Negatively Affect Assisted Reproductive Technology Outcomes.

For patients with endometriosis-related infertility, the impact of previous surgery for endometriosis before assisted reproductive technology (ART) remains controversial, particularly in cases of deep infiltrating endometriosis (DE). To study the impact of previous surgery for endometriosis on ART cumulative live-birth rates in DE patients, a retrospective cohort study included 222 DE patients who underwent ART. DE diagnosis was based on strict imaging criteria and histological confirmation of the disease for women with a previous history of surgery for endometriosis. ART outcomes were compared for patients with and without a previous history of surgery for endometriosis. The main outcome measures were cumulative live-birth rates (CLBR). Prognostic factors were identified by comparing women who became pregnant and those who did not, using an adjusted multiple logistic regression model. Two hundred twenty-two DE patients underwent a total of 440 ART cycles (including fresh and associated frozen-thawed embryo transfers). One hundred fifty-five women (69.8%) had a prior history of surgery for endometriosis. The CLBR was 26% after four ART cycles in the "previous history of surgery for endometriosis" group, while it reached 51.3% after four cycles (p < 0.001) in patients who had not previously undergone surgery for endometriosis. After multivariate analysis, a previous history of surgery for endometriosis (p = 0.001) and a past surgery for endometrioma (p = 0.005) were established as independent factors associated with lower pregnancy rates. Our preliminary results suggest that for DE patients, a previous history of surgery for endometriosis may be associated with negative ART outcomes.

2908 Ultrasound Findings in Patients Referred to an Endometriosis Unit in a Tertiary Centre: Does Previous Surgery Matter?

Study Objective The objective of this study is to analyze the ultrasound findings in patients referred to an endometriosis unit with and without previous endometriosis surgeries over one-year period. Design Retrospective study including 430 patients who had a first visit and an ultrasound scan at an endometriosis referral unit from January to December 2018. Information about surgical history and ultrasound findings was collected. Setting Endometriosis referral unit in a tertiary hospital in Barcelona, Spain. Patients or Participants 430 patients referred to the endometriosis unit were included. Interventions Ultrasound scan was performed according to the protocol stablished in this unit. Measurements and Main Results 177 patients (41.2%) had a previous history of endometriosis surgery. 72.9% of them had one previous surgery and 14.7% had two whereas 12.4% had three or more. Laparoscopy was the main route, which was used in 74.6% of them. The main procedures were endometrioma decapsulation (45.6%) followed by adnexal surgery (19.8%) and deep infiltrating endometriosis nodule excision (16%). Only 2.7% of patients had a previous bowel resection. When comparing the ultrasound findings between patients who have a previous endometriosis surgery with those without, statistically significant differences were found in the presence of ovarian adhesions, ovarian endometriomas, presence of intestinal endometriotic nodules and Douglas-blockage. Conclusion More than 40% of patients referred to the endometriosis unit had had a previous surgery. They had a higher rate of presence of intestinal endometriotic nodules among other ultrasound findings. Thus, it reinforces the need of referral units in order to establish a precise treatment either medical or surgical with high-skilled surgeons.

Serum antimüllerian hormone concentration increases with ovarian endometrioma size

To examine whether serum antimüllerian hormone (AMH) levels correlate with the size of ovarian endometrioma (OMA). An observational cross-sectional study. University hospital. Two hundred and sixty-seven nonpregnant women, aged 18-42years, with no prior history of surgery for endometriosis and a histologically documented ovarian cyst. Surgical management for a benign ovarian cyst. Correlation between serum AMH concentration and cyst size according to OMA and non-OMA benign cyst. Women with OMA were compared with a control group of women who had non-OMA benign ovarian cysts. The AMH assay samples were collected less than a month before the surgery. Between January 2004 and September 2016, 148 women were allocated to the OMA group and 119 to the non-OMA benign cyst group. The AMH concentrations were not statistically significantly different between the two groups (3.7 ± 2.8ng/mL vs. 4.1 ± 3.3ng/mL). A multiple linear regression model accounting for potential confounders revealed that the log10 of the serum AMH concentration positively correlated with the log10 of the OMA cyst volume (R2 = 0.23; coefficient = 0.05; 95% CI, 0.007-0.10). In women no prior history of surgery for endometriosis, serum AMH levels increased with cyst size in cases of OMA.

Risk of miscarriage in women with endometriosis achieving pregnancy through ivf

To investigate whether women with endometriosis achieving singleton pregnancies through IVF have a higher risk of miscarriage. Matched case-control study in Reproductive Medicine Center.It is a retrospective analysis of women undergoing IVF. The study included women who achieving singleton pregnancies with the use of IVF. The study group were women with a history of surgery for endometriosis and those who have ovarian endometrioma at the time of IVF cycle (n=1338). The control group were matched 1:2 according to age, type of cycle (fresh or frozen cycle) and study period (n=2676). The miscarriage rate between the women with and without endometriosis was similar, (22% and 19.5%, respectively, p = 0.067). The odds ratio adjusted for body mass index (BMI), parity, age, duration of infertility, and male factor infertility was 0.09 (95% confidence interval 0.977-1.372). There is no significant difference in the subgroup analyses according to the type of cycle, the number of embryos transferred and in vitro fertilization technique used. The risk of miscarriage did not increase in women with endometriosis achieving pregnancy through IVF.Tabled 1Subgroup analyses on the risk of miscarriageSubgroupEndometriosis Abortions Totaln (%)TotalControls Abortions n (%)P valueCrude OR(95% CI)Adjusted OR(95% CI)Type of cycle Fresh cycles1006225 (22.4)2012405 (20.1)0.1541.143(0.951-1.374)1.154(0.944-1.411)a Frozen cycles33269 (20.8)664117 (17.6)0.2271.227(0.880-1.709)1.198(0.850-1.689)bNo. of embryos transferred 120857 (27.4)19938 (19.1)0.051.599(1.003-2.550)1.68(1.024-2.758)c ≥21130237 (21.0)2477484 (19.5)0.3181.093(0.918-1.301)1.082(0.901-1.299)cIn vitro fertilization technique used IVF944196 (20.8)2078389 (18.7)0.1881.138(0.939-1.379)1.144(0.892-1.466) a ICSI39498 (24.9)598133(22.2)0.3371.158(0.858-1.561)1.278(0.852-1.917) a Open table in a new tab

Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility

Assisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear. We sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype. This was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing invitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models. In all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes. The endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.

Pregnancy outcome in women with endometriosis achieving pregnancy with IVF.

Are women with endometriosis who conceive with IVF at increased risk of preterm birth? Women with endometriosis who conceive with IVF do not face an increased risk of preterm birth. The eutopic endometrium of women with endometriosis has been repeatedly shown to present molecular and cellular alterations. On this basis, it has been hypothesized that pregnancy outcome may be altered in affected women. However, to date, available evidence from epidemiological studies is scanty and conflicting. Data tended to be partly consistent only for an increased risk of preterm birth and placenta previa. Retrospective matched case-control study of women achieving an IVF singleton pregnancy progressing beyond 12 weeks' gestation. Women achieving IVF singleton pregnancies that progressed beyond 12 weeks' gestation at two infertility units were reviewed. Cases were women with a history of surgery for endometriosis and/or with a sonographic diagnosis of the disease at the time of the IVF cycle. Controls were women without current or past evidence of endometriosis who were matched to cases by age (±6 months), type of cycle (fresh or frozen cycle) and study period. Male factor and unexplained infertility were the most common diagnoses in the control group. Two hundred and thirty-nine women with endometriosis and 239 controls were selected. The main outcome of the study was the rate of preterm birth (birth<37 weeks' gestation) regardless of the cause. Secondary analyses were performed for the most common obstetrical complications. The rate of preterm birth was similar in the two study groups (14% and 14%, respectively, p=0.89). The rate of live birth and the incidence of hypertensive disorders, gestational diabetes, small and large for gestational age newborns and neonatal problems also did not differ. In contrast, placenta previa was more common in women with endometriosis than controls (6% versus 1%, respectively; p=0.006): The adjusted odds ratio was 4.8 (95% confidence interval: 1.4-17.2). As for all observational studies, confounders cannot be totally excluded. Moreover, the retrospective study design exposes the findings to some inaccuracies. For example, the independent role of adenomyosis could not be reliably assessed because this diagnosis is complex and would necessitate a prospective recruitment. Second, the selection of controls may also be a matter of concern because some affected women may have been erroneously included in this group. Third, even if the sample size is significant, it is insufficient for robust subgroup analyses. Finally, it is mandatory to point out that our conclusions are valid for IVF pregnancies only, and specific data from properly designed studies are required to support any inference for natural pregnancies. The results of our study suggest that women with endometriosis conceiving with IVF can be reassured regarding the risk of preterm birth. The observed association with placenta previa requires further investigation and may open a new avenue of research. No external funding was used for this study. None of the authors have any conflict of interest to declare.

Risk of miscarriage in women with endometriosis: insights from in vitro fertilization cycles

To evaluate whether women with endometriosis achieving singleton pregnancies with IVF face an increased risk of miscarriage. Matched case-control study. Infertility units. Women achieving singleton pregnancies with the use of IVF were considered. Cases were women with a history of surgery for endometriosis and those who were documented the presence of ovarian endometriomas at the time of the IVF cycle (n = 313). Controls were matched to cases by age (±6months), type of cycle (fresh or frozen cycle). and study period (n = 313). Retrospective review of women undergoing IVF. Rate of miscarriage before 12weeks' gestation. The number of miscarriages in women with and without endometriosis was similar, being 48 (15%) and 60 (19%), respectively. The odds ratio of miscarriage in affected women was 0.76 (95% confidence interval 0.50-1.16). The odds ratio adjusted for body mass index (BMI), parity, duration of infertility, and male factor infertility was 0.81 (95% confidence interval 0.53-1.25). Subgroup analyses according to the type of cycle, the number of embryos transferred, the presence of endometriomas, and the history of surgery for endometriosis did not document any subgroup at significant increased risk of miscarriage. The risk of miscarriage is not increased in women with endometriosis achieving pregnancy with the use of IVF.